University of Birmingham Institute of Applied Health Research, Birmingham, UK.
Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
BMJ Open Respir Res. 2024 May 1;11(1):e001746. doi: 10.1136/bmjresp-2023-001746.
Asthma remains a common cause of hospital admissions across the life course. We estimated the contribution of key risk factors to asthma-related hospital and intensive care unit (ICU) admissions in children, adolescents and adults.
This was a UK-based cohort study using linked primary care (Clinical Practice Research Datalink Aurum) and secondary care (Hospital Episode Statistics Admitted Patient Care) data. Patients were eligible if they were aged 5 years and older and had been diagnosed with asthma. This included 90 989 children aged 5-11 years, 114 927 adolescents aged 12-17 years and 1 179 410 adults aged 18 years or older. The primary outcome was asthma-related hospital admissions from 1 January 2017 to 31 December 2019. The secondary outcome was asthma-related ICU admissions. Incidence rate ratios adjusted for demographic and clinical risk factors were estimated using negative binomial models. Population attributable fraction (PAF) was estimated for modifiable risk factors.
Younger age groups, females and those from ethnic minority and lower socioeconomic backgrounds had an increased risk of asthma-related hospital admissions. Increasing medication burden, including excessive use of short-acting bronchodilators, was also strongly associated with the primary outcome. Similar risk factors were observed for asthma-related ICU admissions. The key potentially modifiable or treatable risk factors were smoking in adolescents and adults (PAF 6.8%, 95% CI 0.9% to 12.3% and 4.3%, 95% CI 3.0% to 5.7%, respectively), and obesity (PAF 23.3%, 95% CI 20.5% to 26.1%), depression (11.1%, 95% CI 9.1% to 13.1%), gastro-oesophageal reflux disease (2.3%, 95% CI 1.2% to 3.4%), anxiety (2.0%, 95% CI 0.5% to 3.6%) and chronic rhinosinusitis (0.8%, 95% CI 0.3% to 1.3%) in adults.
There are significant sociodemographic inequalities in the rates of asthma-related hospital and ICU admissions. Treating age-specific modifiable risk factors should be considered an integral part of asthma management, which could potentially reduce the rate of avoidable hospital admissions.
哮喘仍然是整个生命过程中导致住院的常见原因。我们评估了关键风险因素对儿童、青少年和成人哮喘相关住院和重症监护病房（ICU）入院的贡献。
这是一项基于英国的队列研究，使用了链接的初级保健（临床实践研究数据链接 Aurum）和二级保健（住院患者护理医院入院统计数据）数据。如果患者年龄在 5 岁及以上且被诊断患有哮喘，则符合条件。这包括 90989 名 5-11 岁的儿童、114927 名 12-17 岁的青少年和 1179410 名 18 岁及以上的成年人。主要结局是 2017 年 1 月 1 日至 2019 年 12 月 31 日期间与哮喘相关的住院治疗。次要结局是与哮喘相关的 ICU 入院。使用负二项式模型估计调整了人口统计学和临床风险因素后的调整发病率比。对于可改变的风险因素，估计了人群归因分数（PAF）。
年龄较小的群体、女性以及少数民族和社会经济地位较低的人群，其哮喘相关住院治疗的风险增加。药物负担的增加，包括过度使用短效支气管扩张剂，也与主要结局密切相关。与哮喘相关 ICU 入院相关的风险因素也相似。青少年和成年人群中潜在的可改变或可治疗的关键风险因素是吸烟（PAF 为 6.8%，95%CI 为 0.9%至 12.3%和 4.3%，95%CI 为 3.0%至 5.7%）和肥胖（PAF 为 23.3%，95%CI 为 20.5%至 26.1%）、抑郁（11.1%，95%CI 为 9.1%至 13.1%）、胃食管反流病（2.3%，95%CI 为 1.2%至 3.4%）、焦虑（2.0%，95%CI 为 0.5%至 3.6%）和慢性鼻-鼻窦炎（0.8%，95%CI 为 0.3%至 1.3%）。
哮喘相关住院和 ICU 入院率存在显著的社会人口学不平等。治疗特定年龄的可改变风险因素应被视为哮喘管理的一个组成部分，这可能会降低可避免住院治疗的发生率。
